Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness

ABSTRACT

Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).

Design: multi-center cross-sectional observational study.

Setting: 23 intensive neurorehabilitation units.

Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).

Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity.

Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.

Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.

KEYWORDS:

• Heterotopic ossification
• disorders of consciousness
• vegetative state
• minimally conscious state
• rehabilitation

Acknowledgments

This study has been devised by the Special Interest Group on acquired brain injury and DoC (ABI & DoC SIG) of the Italian Society of Neurological Rehabilitation (SIRN, see http://www.sirn.net). The authors would like to thank dr. Aloise Marta and dr. Corallo Francesco who participated in the study for their help with data collection. A special acknowledgment is for Dott. Marco Sarà and Dr. Maria Chiara Carboncini, died prematurely this year, who collected data for this study in the San Raffaele Post-Coma Rehabilitative Unit of Cassino and in sABI section, Integrated Care Dept of Medical Specialties, AO-Universitaria Pisana of Pisa respectively.

Data availability statement

The data that support the findings of this study are available from the corresponding author [AE], upon reasonable request. [email protected]

Declaration of interest statement

The authors report no conflicts of interest.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.